Extracranial, Renal, thoracic outlet and Mesenteric Flashcards
what is a stroke ?
defined as a neurological deficit that lasts more than 24 hours
what is a transient ischemic attack ?
a neurological deficit that lasts less than 24 hours
what is the main cause of carotid territory ischaemic stroke ?
thromboembolism
what are the carotid territory symptoms?
hemisensory/motor signs , dysphagia and amaurosis fugax
FAST
what investigations would be taken forcarotid occlusiive disease?
lab investigations: CBC, Lipid Profile, coagulation profile, urea and creatinine and glucose
echo
duplex
CTA or MRA could be used pre-operativley
what is the first line of investigationin carotid artery stenosis?
duplex
what is the most appropriate management for carotid disease ?
BMT
CEA/CAS
timing is important
what are the complications of carotid endarterectomy?
stroke
bleeding and hematoma formation
cranial nerve injury (12,10,9)
hypoglossal - tongue deviation
hoarsness of voice - vagus nerve affection
difficulty swallowing - glossopharyngeal
what is the most common pathological condition of the renal arteries ?
atherosclerotic stenosis
what are the management options for atherosclerotic renal vascular disease ?
medical therapy and may be considered for re vascularisation by either endovascular or surgical means
what are the options for renal replacement therapy ?
haemo-filtration
peritoneal dialysis
heamodialysis
transplantation
what type of access is made for renal replacement therapy patients ?
arteriovenous fistula
arteriovenous graft
how long does a native fistula take to mature
and how long does a graft take to mature ?
6 months
a graft takes 6-8 weeks
when should a native fistula be created ?
6 months before need
what is the rule of 6 in the ideal AVF conduct ?
flow rate of at least 600ml/min
should lie less than 6mm below the surface of the skin
minimum diameter of 6 mmi
ideally how many dialysis needles can be placed with AVF ?
2 dialysis needles
what are the common sites for an AVF ?
wrist radiocephalic
wrist ulnobasilic
brachiobasilic
brachiocephalic
what are the access complications ?
stenosis thrombosis infection failure to mature steal syndrome high flow cardiac failure aneurysm formation
where is the thoracic outlet?
region at the top of the rib cage between the base of the neck and the axilla
what are the contents of the thoracic outlet ?
brachial plexus
subclavian vessels
which gender is TOS more common in ?
women
what are the causes of thoracic outlet syndrome ?
anatomical factors such as a cervical rib
fibrous bands
repetitive injuries
what is the most common congenital abnormality causing TOS?
fibrous bands which transverse the thoracic outlet
what are the three forms of TOS ?
neurogenic TOS
Arterial TOS
Venous TOS
what is the most common form of TOS ?
neurogenic
what are the symptoms of neurogenic TOS?
symptoms in the ulnar nerve distribution
pain when raising the arm
paraesthesia on the medial side of the arm
where does the pain radiate with neurogenic TOS ?
radiates to the axilla shoulder and back
what tests provoke positive findings in neurogenic TOS ?
Adson test
Roos test
what is the presentation of venous TOS ?
patient may present with cyanosis and arm swelling
what is paget-schrotter syndrome ?
is a form of upper extremity DVT presennt with venous TOS
what is the rarest form of TOS?
arterial TOS
what is the presentation of arterial TOS ?
attacks of pallor, pain paraethesia
what is the treatment of NTOS
conservative treatment
avoid repetitive ovberhead work
correct posture
strengthen shoulder elevating muscles
when is surgery indicated with NTOS ?
if the conservative treatment failed to improve symptoms
or if the symptoms interfere with work or daily activities
what are the treatment protocols for VTOS ?
thrombolysis and correction of anatomical abnormalities
first rib resection
what are the treatment protocols for ATOS ?
thromboelectomy followed by excision of the cervical first rib
how is the colon protected from ischaemia ?
marginal artery of drummond
what are the types of mesenteric ischaemia ?
acute mesenteric ischaemia
chronic mesenteric ischaemia
where is the problem when it comes to acute mesenteric arterial embolism ?
superior mesenteric artery
where is the problem when it comes to acute mesenteric arterial thrombosis ?
at the vessel’s origin resulting in extensive bowel involvement
what are the causes of nonocclusive mesenteric ischaemia ?
cocaine
vasopressors
hypotension
what are the causes of mesenteric venous thrombosis ?
hypercoaguability from protein s and c deficiency tumor infection pancreatitis venous trauma
what are the signs and symptoms of acute form of mesenteric ischaemia ?
Abrupt severe abdominal pain
urgent need to have bowel movement
fever
nausea and vomiting
what are the complications of acute mesenteric ischaemia ?
sepsis
irreversible bowel damage
death
what lab results can show acute mesenteric ischaemia ?
raised WCC and lactate
what imaging modality can be used to show acute mesenteric ischaemia ?
CTA or CT with IV contrast
what are the signs and symptoms of chronic mesenteric ischaemia ?
abdominal pain that starts 30 minutes after eating
pain that worsens over an hour
pain that goes away within three hours
what is the investigation of choice ?
CTA
what can people with chronic mesenteric ischaemia suffer from ?
unintentional weight loss
fear of eating
acute on top od chronic mesenteric ischaemia
what is the treamtment for mesenteric ischameia ?
revascularization
resection of non viable bowel
what are the indications for CEA ?
more than 50% stenosis in symptomatic patients
more than 70% stenosis in asymptotic patients
fluctuating neurological symptoms , evolving TIA
what is the best management if you have bilateral carotid stenosis ?
fix the more stenotic one first
if the same degree off stenosis , fix the dominant hand first
when should we perform carotid stenting ?
previous CEA and high risk patients
what is the first branch of thee ICA ?
ophthalmic artery
what is the first branch of the ECA ?
superior thyroid artery
